Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Nov 2004
Case Reports[Contribution of the brain natriuretic peptide in neurogenic pulmonary oedema following subarachnoid haemorrhage].
We report two cases of neurogenic pulmonary oedema following subarachnoid haemorrhage. A 58-year-old woman became increasingly dyspneic and needed oxygen support during a few days. ⋯ In both patients, pro brain natriuretic peptide level was increased whereas global cardiac function was normal. The factors initiating its secretion are discussed.
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To evaluate the anaesthesiologists' attitude concerning the perioperative administration of betablockers (BB), especially prophylactic BB, in order to prevent postoperative cardiac complications. ⋯ In practice, anaesthesiologists continued BB during the perioperative period in patients who were on chronic treatment with BB. However, prophylactic perioperative administration of BB in patients with high cardiac risk is still inadequate and dependent on a cardiologic opinion.
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Ann Fr Anesth Reanim · Nov 2004
Case Reports[Morphine overdose due to cumulative errors leading to ACP pump dysfunction].
We report the case of a 67-year-female patient treated with a postoperative patient controlled analgesia using an Abbott Gemstar pump for after nephrectomy. In the postanaesthesia care unit, fifteen minutes after connecting with of the pump (which bag contained 100 mg of morphine) to the patient, respiratory arrest occurred. A morphine overdose was caused by uncontrolled delivery of the entire bag contents by free flowing due only to gravity. ⋯ This incident was the result of multiple misuse: one misconnection of the tubing between morphine bag and the patient thus shunting the antisiphon valve, and two an improper secured PCA cassette in an open position not detected by the pump. The tubing of these pumps and the software were subsequently modified by Abbott, which should reduce the risk of recurring incident. This accident points out that vigilance must remain rigorous in spite of widespread routine use of PCA.
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Ann Fr Anesth Reanim · Nov 2004
Case Reports[Recombinant activated factor VII as a life-saving therapy for severe postpartum haemorrhage unresponsive to conservative traditional management].
Postpartum haemorrhage remains the main cause of maternal morbidity and mortality. Treatment aims at maintaining hemodynamic circulation and preventing shock by stopping blood loss both medically and surgically. We report two cases of major postpartum haemorrhage due to uterine atony. ⋯ RFVIIa might thus be a strong complementary agent in the management of major postpartum haemorrhage. Optimal dose, timing and safety characteristics of rVIIa administration remain to be determined. One patient developed four weeks later thrombosis of both ovarian veins, a complication that can be related to either rFVIIa or to the staged uterine ligations performed during surgery.